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*Cases
O-RADS US 0 - 0:00
O-RADS US 1 - 0:59
O-RADS US 2 - 1:50
O-RADS US 3 - 9:24
O-RADS US 4 - 13:06
O-RADS US 5 - 18:18
Ovarian-Adnexal Reporting and Data System Ultrasound (O-RADS US)
Risk stratification and management system developed to standardize the reporting of ovarian and adnexal pathology in ultrasound imaging.
O-RADS US 0: Incomplete evaluation, further imaging needed.
O-RADS US 1:
Indicating a benign condition with no follow-up necessary.
Corpus Luteum measuring less than 3cm
Ovarian Follicles measuring less than 3cm
All functional cysts fall under O-RADS 1
O-RADS US 2:
Findings are benign with almost 0% risk of malignancy
Simple Cyst Measuring 3-5 cm
Thin walled anechoic cyst
Unilocular - Single chamber
Posterior acoustic enhancement
No internal echoes or solid components
In internal flow on color doppler
Premenopausal patients require no follow up
Postmenopausal patients require 1 year follow up
Simple Cyst 5-10 cm: Premenopausal patients require 8-12 week follow up ; Postmenopausal patients require 1 year follow up
Complex Unilocular Cyst With Smooth Margins less than 3cm: Premenopausal patients do not require follow up, Postmenopausal patients require 1 year follow up & MRI recommended.
Complex Unilocular Cyst With Smooth Margins 3-10cm: Premenopausal patients require 8-12 week follow up, Referral to a Gynecologist and MRI recommended for Postmenopausal patients.
Hemorrhagic Cyst less than 10cm:
Lace-like internal echoes: Clotted blood
No internal vascularity
Posterior acoustic enhancement
Dermoid Cyst less than 10cm:
Hyperechoic structure with posterior acoustic shadowing
Echogenic floating structures
Dermoid Mesh: Dot-Dash pattern (Hair)
No internal vascularity
Endometrioma less than 10cm
Unilocular cyst with homogeneous internal echoes giving a ground glass appearance
Also known as chocolate cyst
Paraovarian Cyst less than 10cm:
Unilocular anechoic cyst outside the ovary
Peritoneal Inclusion Cyst less than 10 cm
Anechoic cyst with septations next to the ovary
Does not have a well defined border
Spider web pattern
Hydrosalpinx: Anechoic, fluid-filled, sausage-shaped, dilated fallopian tube.
Waist Sign: The dilated tube appears pinched or constricted in the middle, resembling the shape of a waist.
Cogwheel Sign: The cross-sectional view of the dilated fallopian tube resembles the shape of a cogwheel or gear, with the fallopian tube's folds creating this cogwheel-like appearance.
O-RADS US 3: Lesions with features suggesting a low risk of malignancy (1-10%).
Multilocular Cyst less than 10cm:
Serous Cystadenoma - Multilocular cyst without solid components, no/minimal internal vascularity and smooth inner wall
Color Score 1: No blood flow.
Color Score 2: Minimal blood flow.
Color Score 3: Moderate blood flow.
Color Score 4: Marked blood flow.
Smooth inner wall
No-Moderate internal vascularity (Color Score 1-3)
Unilocular cysts greater than 10 cm:
Large cysts measuring greater than 10 cm
Includes both simple and complex cysts
Hemorrhagic Cyst, Dermoid Cyst & Endometrioma greater than 10 cm
Unilocular Cyst With Irregular Inner Wall
O-RADS US 4: Lesions that present a moderate risk of being malignant (10-50%):
Unilocular Cyst With 1-3 Papillary Projections
Multilocular Cyst With Solid Elements
Multilocular Cyst Without Solid Elements -- Irregular inner wall and septations
Smooth Solid Mass - Fibroma
O-RADS US 5: Lesions that are highly suggestive of malignancy (Greater than 50% risk).
Unilocular Cyst With ≥4 Papillary Projections
Multilocular Cyst With Solid Elements
Solid Mass With Irregular Contour
Ascites/Peritoneal Infiltration